Program guidelinesAlcohol and other drugs

PART 1 - Overview

CONSULTATION DRAFT Oct 2016

AcknowledgementsThe Department of Health and Human Services gratefully acknowledges the contribution made by service providers of alcohol and other drug treatment services to the development of the consultation draft of these guidelines; in particular the members of the Sector Reference Group on Community Based Alcohol and Other Drug Service Delivery.

If you would like to provide feedback on how these guidelines can be improved, please email AOD.enquiries@dhhs.vic.gov.au

Program guidelinesAlcohol and Other drugs

Part 1 – Overview

Consultation draft

To receive this publication in an accessible format phone 9096 6000, using the National Relay Service 13 36 77 if required, or email AOD.enquires@dhhs.vic.gov.au

Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.

© State of Victoria, Department of Health and Human Services August 2016

Where the term ‘Aboriginal’ is used it refers to both Aboriginal and Torres Strait Islander people. Indigenous is retained when it is part of the title of a report, program or quotation.

Available at https://www2.health.vic.gov.au/alcohol-and-drugs

Contents

Acknowledgements..................................................................................................................................... 2

Alcohol and Other Drugs Program Guidelines......................................................................................6Purpose of the guidelines........................................................................................................................... 6

Using the guidelines................................................................................................................................... 6

Introduction............................................................................................................................................... 7Overview of approach................................................................................................................................. 7

Principles.................................................................................................................................................... 9

Outcomes................................................................................................................................................... 9

Prevention and Early Intervention...........................................................................................................9Prevention................................................................................................................................................... 9

Early Intervention...................................................................................................................................... 10

Harm Reduction...................................................................................................................................... 11

Treatment................................................................................................................................................ 11Access to treatment.................................................................................................................................. 12

Service integration.................................................................................................................................... 13

Referring to the AOD treatment system....................................................................................................13

Stepped care............................................................................................................................................ 14

Treatment streams.................................................................................................................................... 15

Population-specific services...................................................................................................................... 16

Additional clinical support......................................................................................................................... 16

Sector planning, support and capacity building.........................................................................................17

Clients...................................................................................................................................................... 17Victorian AOD Client Charter.................................................................................................................... 19

Equity, diversity and inclusion................................................................................................................... 19

Health Complaints Commissioner.............................................................................................................20

Alcohol and Other Drugs Program Guidelines

Purpose of the guidelinesThese guidelines provide information for funded agencies about the alcohol and other drugs programs and services funded by the Victorian Department of Health and Human Services.

The guidelines are divided into three sections.

Part 1: Program Guidelines - Overview outlines the broad approach the Department of Health and Human Services takes in relation to prevention, harm reduction and treatment.

Part 2: Program Guidelines – Program and service specifications outlines the service specifications for particular programs and services.

Part 3: Program guidelines – Quality, reporting and performance management outlines key regulation and reporting requirements.

This document is Part 1: Overview.

These guidelines outline the Victorian Government’s principles and objectives, key service delivery requirements and minimum performance and reporting standards for the state-funded alcohol and other drugs program.

Using the guidelinesThese documents are to be used to inform the delivery of state-funded programs and services that aim to reduce harm from alcohol and other drugs. These initiatives also contribute to the department’s overall aim of improving the health and wellbeing of all Victorians.

These guidelines should also be used by Boards of Management of agencies delivering services and programs to contribute to continuous quality improvement processes and improving health outcomes for Victorians over time.

To meet these aims, agencies should also use catchment and other service planning tools to allocate resources in a way that meets the needs of people within the catchment and be planning for future changes in alcohol and other drug use patterns.

Victoria funds specialist alcohol and other drug services, which employ clinical and other health care professionals. Consequently, providers have a high-degree of autonomy in determining the most appropriate clinical care provided.

These guidelines do not cover every aspect of care and are not expected to stand in for good clinical judgement of professional service providers.

There is an expectation however that all agencies provided with public funding account for the use of those funds by meeting minimum reporting, performance and incident reporting requirements. All services must also meet quality and safety standards and comply with relevant legislation.

The guidelines complement other documents such as the service agreement with the department, which specifies delivery targets and financial obligations.

Limitations

This consultation draft has been prepared based on existing information and data that describes the Victorian alcohol and other drug service system. The department will work with service providers to update this information over time.

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Introduction

Alcohol and other drugs are estimated to contribute to over $55 billion in preventable health and other harms across Australia each year.1

Many people use alcohol and other drugs without harm. However, some people have mental and physical health conditions associated with their alcohol or other drug use that risks and can shorten their life.

To reduce preventable harms from alcohol and other drugs and to contribute to improving the health and wellbeing of Victorians, the Victorian Government allocates approximately $190 million annually for the drug services program. This includes funding for alcohol and other drug prevention, harm reduction and treatment services. $192.5 million was allocated to the drugs services program in the 2016-17 State Budget.

The majority of funding goes to community sector organisations providing dedicated alcohol and other drug programs and services ranging from general drug harm information, to withdrawal, rehabilitation, counselling and referral. Public hospitals provide some withdrawal services, by arrangement, where there are no other residential withdrawal service available and in cases where withdrawal may have significant risks for the individual.

The Victorian Government recognises that addiction and problematic alcohol and other drug use is a public and mental health issue. Alcohol and other drug addictions are leading global risk factors for the burden of disease and may also manifest some of the characteristics of other chronic and relapsing conditions.2 Additionally, as it is often tied up with complex behavioural and other psychological issues, addiction can take time to resolve.

For the over 28,000 people who access state-funded alcohol and other drug treatment services across Victoria each year and the additional 10,000 people who access registered private health services per year, treatment is just one part of their recovery journey.

Evidence shows that being engaged in study, employment, sport or other purposeful activity, and having stable housing and caring relationships with supportive friends and family, are also important to sustained and long-term recovery.

Overview of approachOn a population-wide basis, Australia’s relationship with alcohol and other drugs may be improving. Alcohol and tobacco use has declined since 19913. Overall, illicit drug use has remained relatively stable, though the prevalence of use of individual drugs has changed. In 2013, about 15 per cent of people had used an illicit drug in the last 12 months, with 2 per cent having used amphetamines such as ice or speed and 1.2 per cent having used heroin. Cannabis is the most commonly used illicit drug and alcohol the most used legal drug.

Additionally, the age a young person first uses alcohol is increasing and more people under the age of 18 are remaining abstinent. Daily consumption of alcohol has declined across Australia, with about 6.5 per cent of Australians drinking daily and 28.2 per cent of people drinking in a way that puts them at risk over the lifetime.

However, alcohol and other drug use is still responsible for over 5 per cent of the burden of disease in Australia and can contribute to heart disease, accident and injury, mental illness, suicide, low birthweight,

1 Collins DJ and Lapsley HM, The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05, Commonwealth of Australia2 World Health Organisation, Global Health Risks: Global patterns of health risk (2012) http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_part2.pdf3AIHW, National drug strategy household survey 2013 detailed report, (2014) http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848

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overdose and blood borne viruses such as HIV.4 There is also evidence to suggest that while some people are using alcohol and other drugs less, there is a small group of people who are using them in a more harmful way. Researchers have found that there is a growing disparity between the way people use alcohol and other drugs, with some people continuing to reduce the amount and frequency of use and at the other end, a small proportion of people using alcohol and other drugs more harmfully.

It is also recognised that regardless of prevention efforts, a small proportion of the total number of people who use alcohol and other drugs will go on to have problems with their use. This involves a range of factors including genetic predisposition, individual psychology, social and economic circumstances and exposure to traumatic events such as sexual and other violence. Consequently, a small proportion of people who use alcohol and other drugs will go on to develop severe dependency issues that puts their health and life at greater risk.

To reduce harm from alcohol and other drug use and to prevent severe dependency issues, the Victorian Government funds programs and services to intervene at a number of different stages from prevention, to tertiary treatment and support during recovery (See Figure 1).

Figure 1: Alcohol and other drug use stages of intervention

The government also makes a broader contribution to preventing problematic alcohol and other drug use in a number of other less direct ways. A range of Victorian Government initiatives all contribute to improving health and wellbeing and prevention. These include initiatives such as:

• the Roadmap to reform: strong families, safe children• new family violence shelters and social housing being developed as a part of the Family Violence

Royal Commission recommendations• Victorian Aboriginal Community Controlled Health Organisations• the Public Health and Wellbeing Plan• Better Care Victoria• Community Health Services across the state, providing health care to highly vulnerable people.

Commonwealth Government policies in relation to General Practitioners and the Medicare Benefits Schedule for example, are also critical to the early diagnosis of a range of health issues including alcohol and other drug misuse and access to specialist services including addiction medicine specialists. The Commonwealth also provides funding to Primary Health Networks to commission a range of health services, including alcohol and other drug services, across Victoria.

Within this context, the Victorian Government allocated approximately $192.5 million to drugs services in 2016-175. The majority of the funding resources, approximately $157.9 million per annum, was allocated to specialist alcohol and other drug treatment services6. Approximately $34.6 million per annum is allocated to drug prevention and control activities, including prevention, early intervention and harm reduction programs and services. The majority of funding is directed to specialist alcohol and other drug treatment services to ensure an appropriate treatment and support response for people most in need of AOD treatment and support.

4 National Drug Strategy Household Survey detailed report: 2013, available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848 5 Department of Treasury and Finance, Budget Paper 3: Service Delivery, State of Victoria (2016) p. 217 Accessed from: https://www.budget.vic.gov.au/budget-papers/ 6 ibid., page 244

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RecoveryRecoveryRecoveryRecoveryRecovery

The department also funds a number of peak and advocacy organisations to support the Victorian alcohol and other drug sector. These include the Victorian Alcohol and Drug Association (VAADA), the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and the Self Help Addiction Resource Centre (SHARC).

The Victorian Government also provides funding to hospitals, ambulances and emergency departments, which are available if a person needs urgent medical care.

PrinciplesThe Victorian Alcohol and Other Drug Program is guided by the eleven treatment principles, developed in 2013. Based on these principles, all alcohol and other drug programs and services are to be:

• Person-centred• Accessible• Integrated and holistic• Responsive to diversity • Evidence informed• Provide continuity of care• Involve people who are significant to the recipient • Inclusive of a variety of biopsychosocial approaches, interventions and modalities oriented towards

people’s recovery • Inclusive of the lived experience of alcohol and other drug users and their families at all levels; and• Delivered by a suitably qualified and experienced workforce.

More information about the treatment principles can be found at the department’s website7.

OutcomesThe Victorian Government seeks to achieve accessible, efficient, effective and responsive alcohol and other drug treatment services.

Attachment 9 provides a summary of indicative types of outcomes the Victorian Government is seeking to achieve for people with an alcohol and other drug problem through the delivery of accessible, efficient, effective and responsive alcohol and other drug treatment services. It also illustrates the type of benefits clients should expect as a result of receiving treatment, acknowledging that alcohol and other drug treatment providers alone will not be able to achieve all of these outcomes.

Prevention and Early Intervention

PreventionThe Victorian Government works with community service organisations and other government departments to prevent the harmful uptake of alcohol and other drug use. Prevention strategies for alcohol and other drugs are aimed at preventing their use in the case of illegal drugs, or harmful use in the case of alcohol and pharmaceutical medications.

A number of mechanisms currently exist which aim to prevent the uptake and harm associated with alcohol and other drug use. These include:

• Informing people about the effects and the harms associated with the use of alcohol and other drugs• Changing laws and regulations that govern sales of alcohol and tobacco

7 The Victorian AOD treatment principles are available from: https://www2.health.vic.gov.au/alcohol-and-drugs/aod-service-standards-guidelines/aod-treatment-principles

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• Providing positive role modelling of alcohol and other drug use• Helping people to reduce stress in their lives; and• Developing safe environments that reduce the risk of harmful use.

The Victorian Government provides funding for a range of programs and services that aim to prevent and reduce the harms associated with alcohol and other drug use. These include a combination of broad-based education and targeted community programs that seek to improve awareness of the harms associated with alcohol and other drug use, strengthen decision-making and promote healthier social and cultural norms. These initiatives are intended to delay or prevent people from using alcohol and other drugs and help those already using these substances to reduce their use in order to minimise harm.

Current Victorian Government prevention and early intervention approaches include:

• Information services like DrugInfo• Community programs like GoodSports and the Prevent Alcohol and Risk Related Trauma in Youth

(PARTY) Program• Self-management tools like SayWhen • Structured support programs like Ready2Change• Family support services and programs like Family Drug Helpline

Early InterventionFor a small proportion of people, their alcohol and other drug use will become problematic. Intervening early can break the cycle of harmful or problematic alcohol or other drug use. This may involve addressing underlying issues such as a mental illness and developing strategies to support people to minimise their alcohol and other drug use.

Turning Point’s DirectLine can provide people who have harmful alcohol and other drug use with a brief intervention. Turning Point has also developed its Ready2Change online and telephone program that can provide support to people who are waiting for alcohol and other drug treatment or require less intensive interventions. The Commonwealth funded Counselling Online is also available for text-based chat counselling for people.

Say When is an online screening and self-assessment tool available for people who may need to reduce their drinking but do not have a clinical dependency issue. It provides a web-based tool for people who would like to check whether they are drinking at harmful levels and learn strategies to reduce drinking, particularly in peer situations.

The Victorian Government funds the Youth Support and Advocacy Service (YSAS) and contributes towards its Youth, Drug and Alcohol Advice Service (YoDAA) to provide a range of information and support for young people to help them better understand the impact of alcohol and other drug misuse. They also provide access to brief interventions, treatment and a number of other community and support services.

Unfortunately, people may not recognise they have a problem relating to their consumption of alcohol and other drugs until they present at court or at a hospital emergency department. The Victorian Government funds a number of diversion programs for first-time offenders, such as the First Offender’s Court Intervention Service (FOCiS).

Twenty-seven emergency departments across Victoria provide improved responses to people with alcohol and other drug presentations. Presentation at an emergency department can support a person to take steps to reduce harmful alcohol and other drug use and can be a key referral point for alcohol and other drug treatment services.

General Practitioners are also able to refer people to appropriate treatment and support that might help a person with their alcohol and other drug use, where drug dependency has not yet become severe.

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Harm Reduction

The Victorian Government is committed to reducing the harm associated with alcohol and other drug use. Harm reduction refers to interventions that are evidenced based public health strategies that aim to reduce the negative consequences (health risks, morbidity, mortality, social dislocation and criminal activity) associated with alcohol and other drug use.

Every intervention delivered by Victorian alcohol and other drug treatment and harm reduction services should seek to reduce the harms caused by substance misuse. The department encourages a recovery-oriented approach within a harm minimisation framework, acknowledging that treatment and support should build on people’s own resilience and resources. Recovery-oriented approaches recognise that people who access harm reduction services come from different paths and their goals and journey are individual and unique.

Harm reduction service providers discuss all aspects of safer alcohol and other drug use, for a variety of substances and consumption methods. These services provide access to sterile injecting equipment to reduce HIV and other Blood Borne Virus (BBV) transmission, education and information on how to reduce risk of drug related harm, overdose and health promotion. They also educate family and friends on how to respond to overdose, fund peer and outreach workers and pharmacotherapy treatment including opioid substitution treatment.

Current Victorian Government harm reduction approaches include:

• Access to sterile injecting equipment to reduce Blood Borne Virus (BBV) transmission• Education and information on how to reduce risk of injecting related harm, overdose, health

promotion, promotion of safer drug use• Education for peers, family and friends on how to respond to opioid overdose using naloxone• Treatment for dependency issues i.e. Pharmacotherapies including opioid substitution treatment• Peer and outreach workers

Treatment

People concerned about their alcohol and other drug use may require specialist alcohol and other drug treatment.

Substance dependence is a complex but treatable condition, that has a strong neurological impact and influences behaviour. Alcohol and other drug treatment services use evidence-based treatment models to help people stabilise or reduce their problematic substance use.

Recovery from dependence can improve a person’s quality of life, by improving life stability and helping them improve their physical and mental health and wellbeing. Other treatment outcomes may include improved relationships with family, friends and their community, greater engagement with work or study and reduced offending behaviours

The department takes a recovery-oriented approach, which means we understand and acknowledge that relapse is common and people may need to enter treatment a number of times before achieving sustainable, non-problematic alcohol and other drug use.

Victorian Government funded alcohol and other drug treatment services are available to all people regardless of the particular drug or drug combination being used. Treatment services are expected to adjust to changing alcohol and other drug use patterns and to be experts in relation to the most appropriate treatment required in different circumstances.

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Most people with severe alcohol and other drug dependency issues will have a range of other issues, which may be caused by, or contribute to, their substance use. These may include underlying mental health issues, acquired brain injury or behavioural issues. Treatment services must be able to provide services, or know where a person can access services, that can help to address a range of issues.

There is also a range of clinical advisory services available to support staff to make appropriate decisions. This includes Turning Point’s Drug and Alcohol Clinical Advisory Services (DACAS), the Statewide Neuropsychology Service, the Specialist Alcohol Consulting Service and a clinic for complex client assessment.

Drug use patterns change and there has been a very clear and rapid change in the demand for amphetamine treatment, particularly amongst 20-34 year olds since 20118. Treatment services are expected to continue to provide appropriate services for this group.

Over the past 10 years alcohol has remained the most common reason to seek treatment and has continued to steadily increase, accounting for approximately half of all clients. Alcohol is also mentioned in about 70 per cent of all alcohol and other drug related ambulance attendances. The second most common primary drug of concern is cannabis, which has remained stable over the past 10 years9. During the same period, heroin as a drug of concern has declined from 24 per cent to nine per cent.

In Victoria, a variety of treatment services are available so that people can get the most suitable treatment and support for their needs. Treatment can be tailored for an individual to reflect the severity of their alcohol or other drug dependency and their broader life circumstances. An individual may access a mix of treatment services in their home, at a day program at a community organisation, in inpatient residential services in the community or in a hospital.

While the majority of alcohol and other drug services are funded by the Victorian Government, private alcohol and other drug treatment is also available. This includes alcohol and other drug treatment provided from private hospitals. The cost of private health services to individuals depends on their private health insurance cover and the charging practices of clinics.

Victoria’s state-funded alcohol and other drug treatment system is typically free. There are no fees or charges for assessment, counselling, therapeutic day rehabilitation programs, non-residential withdrawal or care and recovery coordination services.

Some residential services charge a nominal fee. For example, publicly funded residential rehabilitation services may charge a rental fee. This is usually a percentage of Centrelink payments and these payments vary from service to service.

Residential withdrawal services may also charge nominal fees to clients for adjunct therapies, activities and medications. Some services ask clients to contribute (generally $5.00 to $30.00) for pharmaceuticals, complementary therapies and activities.

Access to treatmentThe Victorian Government funds statewide and catchment based entry points to the alcohol and other drug service system.

DirectLine delivers a statewide screening and referral service for people seeking information, screening and referral. People telephoning the 24/7 service may also receive a brief intervention or more structured treatment response, as required.

Catchment based intake and assessment services are critical entry points into the Victorian alcohol and other drug service system across Victoria. Intake and assessment services work closely with DirectLine’s statewide screening and referral service and other treatment providers to provide client intake, screening, assessment and referral to treatment, including the delivery of brief interventions.

8 Turning Point, Trends Analysis, report commissioned by the Department of Health and Human Services, 11 March 2016.9 ibid.

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Alcohol and other drug treatment services also offer screening and assessment for people seeking treatment from service providers in their local community.

People seeking treatment may be referred to alcohol and other drug intake from a range of health and welfare providers, or self-refer. Such referral points may include General Practitioners, Community Health Services, local hospitals and other specialist and generalist providers.

Service integrationStrong integration with other services in the broader alcohol and other drug system and other sectors is critical to ensure that a client’s holistic needs are being met and that their continuing care can be carried out effectively. Integrated care is especially important for clients with dual or multiple diagnoses, or a range of complex needs impacting on their ability to benefit comprehensively from alcohol and other drug treatment interventions.

All state funded services are expected to work collaboratively with other services to ensure clients receive integrated and holistic support throughout their recovery. The alcohol and other drug treatment system integrates with other health, human services and justice sectors in several ways:

• A single catchment based intake and assessment provider facilitates client referrals into and out of the AOD treatment system in each catchment. Other service providers can refer clients to intake and assessment where they have concerns about substance misuse.

• The care and recovery coordination function for complex clients supports integration of service delivery across multiple services. Where a client is involved in a range of services or programs (such as housing and employment programs) the CRC works collaboratively with other services to ensure the range of client needs can be met. A designated Aboriginal CRC function and expertise in responding to clients presenting with an acquired brain injury (ABI) is also required in each catchment.

• Catchment based service delivery and planning supports the establishment of strong linkages between alcohol and other drug services and other service providers at the local level, to ensure service delivery is tailored to client needs.

Referring to the AOD treatment systemOther service providers including those from the health, human services and justice sectors have clear pathways for referral and integration with AOD treatment services:

• Any health and human service provider, including general practitioners, can contact the statewide support service DirectLine (1800 888 236) which provides alcohol and other drug information, advice and referral options.

• Any health and human service provider, including general practitioners, can refer clients to the designated AOD intake and assessment provider in their relevant catchment.

• General practitioners licensed to prescribe pharmacotherapy and those wishing to refer a client to a community-based pharmacotherapy provider or specialist pharmacotherapy service can do so directly, without notifying the catchment based intake and assessment provider10.

• Any service provider can refer clients directly to AOD residential services provided they have been comprehensively assessed, either by the catchment based intake and assessment service or the residential service provider.11

• Justice agencies refer clients into AOD treatment through ACSO COATS. Refer to www.acso.org.au/connect/coats

10 Refer to the Intake and Assessment Guidelines at Attachment 511 Provided the completed assessment is lodged with the intake and assessment provider.

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General PractitionersIncreased GP engagement can improve alcohol and other drug treatment outcomes and reduce the costs of treatment.1213 Alcohol and other drug services can assist clients to have better treatment outcomes and reduce demand on alcohol and other drug treatment services by maintaining a close working relationships with client’s GPs.

Where possible, alcohol and other drug services should identify if a client has a GP and seek consent to engage with the GP.

Where possible and with the client’s consent, services can contribute to continuity of care by keeping the GP updated of the client’s alcohol and other drug treatment progress. For example, this could include notifying the client’s GP when the client has been accepted into treatment, providing the GP with the client’s Individual Treatment Plan, and notifying the GP when the client has completed a course of treatment.

In some cases, a GP may refer a client to a service or treatment type that is not a good match for the client’s needs. When this occurs, the service should consult with the GP to determine the most appropriate treatment plan for the client’s needs.

Stepped careThe department supports a stepped care approach where it is easy for clients to move up or down levels of care according to their need.

Under a stepped care model, clients can move seamlessly between services in response to higher or lower levels of risk and acuity. This is particularly effective in withdrawal settings where high risk clients treated in hospital settings may be stepped down to community residential withdrawal units once their condition has stabilised. Stepping up occurs when a person requires a greater level of care than available at their existing provider, in order to provide appropriate treatment, support and staffing.

Priority access to treatment Victorian Government funded alcohol and other drug treatment works on the principle that people who are most in need of treatment are prioritised for access. Treatment providers have the discretion to assess who is most in need and who requires treatment based on clinical judgement, existing case load and the best management of client flow through different treatment streams.

Need is based on the severity of the alcohol or other drug dependency, including frequency and amount of use and other life complexity factors such as being at risk of experiencing family violence, homelessness, or being required to attend treatment as a part of a court order.

All services are allocated on the basis of greatest clinical and other need, regardless of drug type. Alcohol and other drug treatment services are non-drugs specific. This means an individual who meets clinical and other needs assessments can receive a service, regardless of the drug or drugs being used.

Priority for alcohol and other drug treatment services is given to people who are identified as being at most risk of short-term harm by their alcohol or other drug problem at screening and assessment.

Where there are similar levels of clinical need, priority is given to those people who:

• Have dependent children who are reliant on them for their safety and wellbeing • Are in contact with the justice system, particularly those referred to treatment by courts, corrections,

police or parole boards• Have a history of long-term homelessness• Identify as Aboriginal and/or Torres Strait Islander people

12 Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y. Integrating primary medical care with addiction treatment: a randomized controlled trial. JAMA. 2001, Oct 10;286(14):1715-23.13 Mertens JR, Flisher AJ, Satre DD, Weisner CM. The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients. Drug Alcohol Depend. 2008 Nov 1;98(1-2):45-53.

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• Have a co-existing intellectual disability or acquired brain injury; and/or• Have a mental illness• Are subject to or have been discharged from compulsory treatment under the Severe Substance

Dependence Treatment Act 2010• Have identified issues relating to family violence• Require treatment as a part of a Court Order to achieve reconciliation with their children.

Only where there is more than one eligible person with a similar level of severity and need should priority of access be determined on the basis of length of time that someone has waited for alcohol and other drug treatment services. This eligibility criterion applies to all alcohol and other drug treatment programs and services.

Treatment streamsAlcohol and other drug treatment services in Victoria are delivered through the following treatment streams and programs:

• Counselling• Non-Residential Withdrawal • Residential Withdrawal• Therapeutic Day Rehabilitation• Residential Rehabilitation• Care and Recovery Coordination• Pharmacotherapy

These streams are described below and included in Figure 2: Treatment System components.

Care and Recovery CoordinationFor people with complex needs, Care and Recovery Coordination is available to assist the person to navigate treatment and to support them if they are waiting to access treatment. It also supports a person to plan for exit from treatment and to access other services that can help the person with housing, training, education, employment, or other support that can help prevent relapse.

CounsellingCounselling supports positive behavioural change in people through providing evidence-based therapeutic guidance.

Therapeutic Day RehabilitationTherapeutic day rehabilitation programs are intensive, structured interventions that aim to address the psychosocial causes of alcohol and other drug dependence.

Non-Residential WithdrawalNon-residential withdrawal services support people with alcohol and other drug dependency issues to safely achieve neuroadaptation reversal from addiction.

Residential Withdrawal Residential withdrawal services support clients to safely achieve neuroadaptation reversal from alcohol and other drugs of dependence, in a supervised residential or hospital facility.

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Compulsory drug withdrawal under the Severe Substance Dependence Treatment Act (2010)

The Severe Substance Dependence Treatment Act (2010) provides for a 14 day period of detention and compulsory withdrawal for people who urgently require treatment to save their life or prevent serious damage to their health. This program delivered under the Act is provided by St Vincent’s Health.

Residential RehabilitationResidential rehabilitation services provide intensive interventions that address the psychosocial causes of alcohol and other drug dependence in a structured residential setting.

PharmacotherapyPharmacotherapy is the use of prescribed substitution medication (such as methadone, acamprosate, naltrexone and buprenorphine) to assist in the treatment of addiction. Pharmacotherapy is accessed through GPs, nurses and alcohol and other drug treatment services.

Population-specific servicesPopulation-specific alcohol and other drug treatment services are available for cohorts with specific needs:

• Youth alcohol and other drug services (including non-residential and residential)• Aboriginal alcohol and other drug services• Forensic alcohol and other drug services

Youth alcohol and other drug servicesYouth services offer treatment and support to vulnerable young people who are 12 to 25 years and their friends and family, to help address their alcohol and other drug use issues.

Aboriginal alcohol and other drug servicesAboriginal services offer holistic, culturally-appropriate care, support and treatment to Aboriginal clients, families and communities to help reduce the harms associated with alcohol and other drug use.

Forensic alcohol and other drug servicesForensic-specific programs and services aim to reduce harms associated with alcohol and other drug misuse, including related offending behaviour.

Additional clinical supportThe department funds a number of services to provide additional clinical advice or support when required. This includes the:

• Drug and Alcohol Clinical Advisory Service (DACAS)• Statewide Neuropsychology Service• Complex Client Assessment Clinic• Victorian Dual Diagnosis Initiative • Support for LGBTI people through the Victorian Aids Council• The Women’s Alcohol and Drug Service at the Royal Women’s Hospital.

Further information on additional clinical support is available in Part 2: Program and Service specifications.

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Sector planning, support and capacity buildingThe department funds a variety of initiatives to support the Victorian alcohol and other drug service sector, including funding peak bodies and advocacy organisations, facilitates renewal grants and research.

Further information is available under Part 2: Program and service specifications - Sector planning, support and capacity building.

Catchment PlanningAlcohol and other drug services are delivered within 16 catchments across the state. There are seven catchments in rural and regional Victoria and nine catchments in metropolitan Melbourne.

Catchments are geographic boundaries that are identified to facilitate improved collaboration, planning and service coordination between alcohol and other drug services and other health and welfare services in that area. Catchments should not be used to restrict client access and choice in service provider.

Catchment planning allows for service planning to occur across a defined location. In this way, needs can be assessed and recommendations made about how to best optimise and allocate existing resources to places and people with the highest need within the catchment.

Catchment planning means community service organisations can find practical ways of building links within the catchment area that improves the ease of referral and access to a range of appropriate support services for people with alcohol and other drug issues.

For more information, please see Part 2 Programs and services - Catchment based planning.

A variety of data relating to alcohol and other drug issues can be accessed via AODstats at http://www.aodstats.org.au/

Clients

Alcohol and other drug treatment services meet the treatment and support needs of people who have alcohol and other drug use issues and their families, including consideration of the needs of dependent children of clients.

Services are targeted primarily to people with serious issues arising from their use of alcohol or other drugs and who are:

• At risk of long term harm or impairment• Not able to be assisted by primary health providers alone.

Younger clients (people aged 16 years or older) are eligible to access adult services. In such instances, service providers are expected to deliver age and developmentally appropriate service responses. Young people (aged up to 25) should be also offered the choice of referral to a youth specific service, as appropriate.

Alcohol and other drug treatment services should have the capacity to address all harmful alcohol and other drug use and reduce the damaging effects of these on individuals and their families. This includes the use of alcohol and tobacco as well as pharmaceutical drug misuse, illicit drug use, poly drug use and the use of synthetic substances.

Alcohol and other drug services should be responsive to the shifting patterns of use over time and should have the capacity to orient service delivery to attend to specific alcohol and other drug use trends as they arise.

Equitable access to services must be provided to groups of people who are particularly vulnerable or are experiencing high levels of disadvantage. The client population in a given catchment should reflect the

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cultural and demographic diversity of the local population and the expected over-representation of disadvantaged groups, such as people experiencing homelessness or mental illness. Specific strategies and cross-agency partnerships are expected to meet these needs as required. For more information, please see below under Equity, diversity and inclusion.

Forensic clientsForensic clients represent a significant proportion of presentations at Victorian alcohol and other drug treatment services. Service delivery to forensic clients is considered a core function of these services.

The Australian Community Support Organisation (ACSO) provides intake and assessment for this client group, with individual clients referred to appropriate alcohol and other drug treatment services based on their assessed needs.

It is anticipated that a higher proportion of forensic clients may be assessed as complex through the intake and assessment process. Some may also be eligible to receive care and recovery coordination support throughout their treatment. For more information, please see Part 2: Program and service specifications, under Forensic programs and services.

Family supportFamilies and other support people can be critical for a person’s recovery from harmful alcohol and other drug use. Families may provide important emotional support, as well as practical assistance. At times, this support can make a significant difference to a person’s recovery journey.

Service providers, as part of their core service delivery, should:

• Engage family members in the development and review of a client’s individual recovery plan, as appropriate.

• Consider the needs of family members and dependent children throughout the treatment process.

This should include:

• Provision of information and advice regarding their support role and associated challenges, including information on alcohol and other drug dependence or abuse and other issues such as mental health, and how to identify early warning signs and provide positive responses in challenging circumstances.

• Provision of supported referral to a range of relevant community services that can assist with the safety and wellbeing of the family members, in particular the needs of dependent children.

Consistent with a family focused approach, family members, including the dependent children of a person who is a client of an alcohol and other drug treatment service, are eligible for focused support.

This can be provided in variety of ways:

• Family drug support services including information, advice and counselling are accessed through selected community health providers in each catchment

• Brief interventions, single session therapies and referral are available through Intake and Assessment services

• Information and advice is available through support services such as Family Drug Help• Family drug education programs are available, such as Breakthrough: Ice education for families• Information and advice is available through Directline

For more information, please see Part 2 – Programs and Service Specifications – Family Support.

Victorian AOD Client CharterAll Victorian funded alcohol and other drug services are required to deliver services in ways that are consistent with the 2011 Victorian alcohol and other drug client charter14.

14 The Client Charter can be found at https://www2.health.vic.gov.au/alcohol-and-drugs/aod-service-standards-guidelines/aod-client-charter

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The charter outlines the responsibilities of services delivering alcohol and other drug treatment in Victoria, including compliance with the Victorian Charter of Human Rights. It also outlines the rights and responsibilities of people using Victorian alcohol and other drug services.

Under the charter, the responsibilities of agencies providing alcohol and other drug services in Victoria are to:

• Treat clients with respect, dignity and courtesy• Provide an accessible service that takes into account individual and cultural diversity• Plan and develop treatment plans and strategies in collaboration with clients• achieve and maintain appropriate standards of proficiency and participate in ongoing professional

review and development• Provide services in a safe environment and ensure that duty of care is maintained• Ensure client information is kept confidential unless disclosure is otherwise authorised• Provide adequate information to clients about organisational and independent complaints processes• Adhere to relevant professional and AOD codes of conduct and ethics• Comply with the Victorian Charter of Human Rights15.

Equity, diversity and inclusionAs Victoria’s population becomes increasingly diverse and has more complex needs, our services and programs need to respond to cultural differences in the community.

People from diverse backgrounds may find it difficult to navigate unfamiliar services, or may need additional services or face discrimination. Services and programs must consider strategies to address access, working to support people in a way that reduces health inequalities, while ensuring people’s overall needs are met.

It is critical that we provide culturally safe environments in which individuals are not exposed to bias, discrimination or inappropriate behaviour. Providing a culturally safe and responsive environment empowers clients to make decisions on their own health and wellbeing.

All Victorian AOD services are required to provide a friendly, welcoming and culturally safe environment for all clients, including Aboriginal people16, people from culturally and linguistically diverse backgrounds17 and Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) people18 and their families. Inclusive practice is an essential part of the delivery of health and human services.

For further information on Victoria’s diverse populations, please see the department’s website.19

For key policies that inform alcohol and other drug service delivery, please see Attachment 2: Legislative and policy context.

Health Complaints CommissionerFrom February 2017, health services, including alcohol and other drug services, will be required to meet the Code of Conduct included in the Health Complaints Act.

People who receive treatment from a private or publicly funded health service, including an alcohol and other drug service, will be able to make a complaint to the Health Complaints Commissioner for

15 The Human Rights Charter can be found at: http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/PubStatbook.nsf/edfb620cf7503d1aca256da4001b08af/54D73763EF9DCA36CA2571B6002428B0/$FILE/06-043a.pdf16 For further information on Aboriginal AOD treatment, please see Part 2 of the guidelines, or https://www2.health.vic.gov.au/alcohol-and-drugs/aod-treatment-services/aod-treatment-services-for-aboriginal-people17The department’s cultural diversity plan is available from: https://www2.health.vic.gov.au/about/publications/policiesandguidelines/dhhs-delivering-for-diversity-cultural-diversity-plan-2016-1918 For information about AOD and LGBTI inclusion please see the Rainbow e.Quality Guide: https://www2.health.vic.gov.au/rainbowequality19 For information on diverse populations, please see: https://www2.health.vic.gov.au/about/populations

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consideration and possible investigation. A person’s family, friends, carers and even other health services, are also able to make a complaint on another person’s behalf.

For more detail on program and service delivery requirements, please refer to:

• Part 2: Program and service specifications• Part 3: Quality, reporting and performance management

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Figure 2: Treatment system components

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Therapeutic Day Rehabilitation

Non-residential withdrawal

CounsellingResidential rehabilitation

Residential withdrawal

Aboriginal-specific services

Youth-specific services

NEW CLIENTS

Care and Recovery

Coordination

DirectLineStatewide centralised

screening and referral

ACSO COATSStatewide

assessment and referral for

forensic clients

Catchment based Intake &

Assessment

General or specialist health and community

services

Catchment Based Planning

Pharmacotherapy services

**See the Intake and Assessment Guidelines for further detail on referral pathways between treatment services**

KEY:Existing clients who have previously been comprehensively assessed by catchment based intake and assessment can be referred directly to (or between) AOD treatment services, provided that the catchment based intake and assessment service is notified of the referral. Clients can still be referred directly to a community-based pharmacotherapy provider or Specialist Pharmacotherapy Service.

Client referral pathways through catchment based intake and assessment 

Client entry points

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